Profile and Outcome of Patients Presenting with Acute Heart Failure in Emergency Medicine Department at Muhimbili National Hospital, Dar Es Salaam Tanzania

Abstract

Background: Heart Failure (HF) is the most common cause of acute dyspnea among elderly patients in the emergency department(ED) and the most common cause of death among patients presenting to the ED with dyspnea. There is rarity of data on the profile and outcome of patients who present with Acute Heart Failure in emergency situations, especially within limited resource settings. Aim: We aimed to determine the profile and outcome of adult patients with AHF who presented to the emergency department of a national referral hospital in a limited resource setting. Methods and Material: This was a prospective cohort study of adult (≥18 years) medical patients presenting to the Emergency Department of Muhimbili National Hospital (EDMNH) in Dar-es-Salaam, Tanzania with AHF from September 2019 to February 2020. We used the Framingham Criteria to diagnose the patients with AHF. Patient demographic data, clinical presentation and ED management provided, and ED disposition were recorded. Patients were followed in-hospital until death/discharged from the hospital. The primary outcome of mortality was summarized using descriptive statistics and analyzed using counts, proportions, median, interquartile ranges (IQR), 95% confidence interval(CI), relative risk (RR) and p-value. Results: A total number of 12,184(100%) adult patients presented to the ED during study period and742(6.1%)patients presented with difficulty in breathing, in whom we enrolled 196 (26.4%) patients with AHF who were eligible and consented to be in the study. All of the patients presented with difficulty in Breathing 196(100%) and the Chest pain 84 (42.9%) was the frequently encountered ED complaint, Hypertension 92(46.9%) was the most frequently reported comorbidity. Median length of stay was 7days (IQR 3-11days).The most common HF drug used were Diuretics (35.2%).Dilated Cardiomyopathy (33.7%) was the most common final diagnosis. In hospital mortality occurred in 54 (28.6%) patients. Among the risk factors for mortality were receipt of inotropes Relative Risk (RR) 2.4 (p<0.0001), receipt of endotracheal intubation (RR) 2.9 (p<0.001), Intensive Care Unit (ICU) admission (RR) 4.3 (p<0.0001) and admission in non-cardiac ward (RR) 1.7 (p=0.03). Conclusion: In this ED of a LMICs, Acute HF affects patients at middle aged adults. Hypertension was the most common comorbidity among these patients. We found high mortality among patient presenting with AHF. Future studies should focus on evaluating and improving risks for AHF so as to improve outcome.